To a certain generation, Marcus Welby, M.D., was not just a television character. He embodied a certain kind of care - the physician who made house calls.
All but forgotten, house calls are making a comeback. This makes perfect sense for the homebound, which is a rapidly growing portion of the population nationwide and especially in New Jersey.
In fact, about 15 percent of Americans are 65 or older, a percentage that is set to grow steadily in the coming decades as baby boomers reach retirement age. Even some boomers' oldest children aren't that far away from retirement. These demographic realities will put increasing pressure on long-term health care. Regardless of what happens to the Affordable Care Act's coverage of seniors in assisted living and at home they, how health care professionals handle the growing demand can't be predicted, but one aspect is already becoming clear: The boomers aren't going quietly into nursing homes.
According to the advocacy group, Justice in Aging, boomers prefer aging at home, which means shifting the level of medical care they receive where they reside. This is where reviving the practice of house calls makes complete sense.
Homebound patients are not driving, working out of the house or regularly traveling, which means access to care is typically limited. That's why home visits by physicians are such a positive service. Regular in-home exams will ensure better care.
Not only will patients be regularly checked, but also by visiting their homes physicians can assess what's going on in the residence. Is the home properly fitted for a homebound patient with grab bars and ramps to ensure safety and ease of mobility? Are there proper foods in the kitchen and is the home clean? All are vital components to ensuring better health outcomes.
Certainly the kinds of testing done in a home are less than might be expected at a medical office but still, the early data - not to mention common sense - suggests a better health standard of living when the homebound are regularly visited by health professionals. And, with the current cost pressure on medical practioners, home visits actually lower costs by keeping the homebound out of hospitals at a far greater rate than what currently occurs.
Recent studies have shown that taxpayers can also reap the benefits of physician house calls; A demonstration conducted by the federal Centers for Medicaid and Medicare Services last year showed that delivering comprehensive primary care services at home to Medicare recipients with multiple chronic illnesses saved an average of $1,010 per beneficiary. The evidence is so compelling that the CMS study prompted bi-partisan, federal legislation that would provide financial incentives to primary care practitioners who achieve savings by caring for elderly and disabled patients in their homes. At the state level, there is no reason why New Jersey couldn't achieve similar Medicaid savings by encouraging more primary care physicians to make house calls.
Other states have recognized these improved health outcomes and savings to taxpayers. In the state of Washington, 85 percent of residents with long-term health care needs receive services at home. Not all of that care, of course, comes from physicians, but it is an important component. It's an example New Jersey should pay attention to, especially with a gubernatorial election now under way.
Some will fondly remember "Dr. Welby" but in reality visits like the ones he made should become a regular part of care for older residents today in New Jersey.